- Evolent (Denver, CO)
- …- **Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality improvement environment- ... to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed… more
- CVS Health (Denver, CO)
- … system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a ... As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes...*Two (2) or more years of experience in Health Care Delivery System eg, Clinical Practice and… more
- Humana (Denver, CO)
- …health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director ... and communication skills + 5 years of established, post-residency clinical experience + Knowledge of the managed care... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products +… more
- Humana (Denver, CO)
- …ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- State of Colorado (Lakewood, CO)
- …conceptualizations through weekly clinical meetings with mental health staff, clinical observation of youth, communication with direct care staff regarding ... Clinical Team Leader, Behavioral Health and Medical Services...is the agency statutorily mandated to provide for the care and supervision of youth committed and detained by… more
- State of Colorado (Pueblo, CO)
- Social Work/Counselor III- Clinical Group Facilitator COT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039848) Apply Social Work/Counselor ... III- Clinical Group Facilitator COT Salary $82,620.00 - $115,668.00 Annually...partner. CMHHIP is a 24 hour behavioral health acute care facility that is intended to provide a safe,… more
- State of Colorado (Pueblo, CO)
- Clinical Security Officer I - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5016124) Apply Clinical Security ... order to obtain life skills. Description of Job Summary of Position: The Clinical Security Officer will provide crisis intervention, to ensure the physical safety… more
- State of Colorado (Pueblo, CO)
- Clinical Safety Specialist I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5015553) Apply Clinical Safety Specialist I - CMHHIP ... and procedures, assists with documenting incidents related to safety violations in patient- care areas, works with the treatment teams, and assists nursing and … more
- Evolent (Denver, CO)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... you ready to make a meaningful impact on patient care in a non- clinical setting? Join our...to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals .… more
- Highmark Health (Denver, CO)
- …to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. ... DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more